07-104394 CITY OF..41/4**4 /f \ —1 _.1
Federal Way RECEIIIP PERMIT 2-" •
COMMUNITY DEVELOPMENT SERVICES MF CO M E EL PL D E EN 120
33325'8 RAL WAVENUE SOUTH• 3 BOX 9718 UG 0 8 APPLICATION
FEDERAL WAY,WA 98063-9718 TO
253 35.2607•TAX 253-835-2609 .f,
limy,.tit loffeder 1univ.con, + `�`'�,
The following is rec nformation/1)
ncomplete p licJic2tFert will not be accepted. Please print legibly(in ink)or type.
• F.
S PROPERTY INFORMATION . • ' •
SITE ADDRESS ` J)GUaZuAlc,i01-01 ' • eUNIT# 6 I D
ASSESSOR'S TAX/PARCEL# a - _..bo1/45.-c) LOTSIZE(sJ)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
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. 'PROJECTINFDRMATION . .. ..
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on thispermit onl
/ 00 ' ��& WY6C \n -) 7 . E
S
PROJECT NAME(Name of Business or Owner Last Name) Wi►i.e, S 1`I e j
• .
"PEOPLE
IFRMATION
dg*F `
PROPERTY NAME ' 9 "/j1\ "c`� Oy PRIMARY PHONE
OWNER 'MAILRES ATE Z
E-MAIL ADDRESS
\it
• CONTRACTOR IRISMPANY NAME - AP CANT NAME A f OFFI E PHO
Ll DRESS h •
` A l v `) C_Ikb E . e ,.eA
QY 'F FEDERAL WAY USMNESS LICEN NUMBER EX IUN DATE F UMB
{_Aso
COPY of eezd ttgalttd Ccf -v4
NTRAC......T���ORRS RREGISTRATI N NUM ER///'''��� ///- EXP TION TE E-MAIL ADDRESS
with eeeh eppLeatlon I /A C.F.
(O�O i08' —
APPLICANT ; OMPANY NAME 1 � .. APPLICANT NWE OFFICE PHONE
ecip
✓IL A I E ►1
cv\TATEZIPLowy) n ) CELLONE <%/
• LA IONSHIPTOPROJECT I FA UMB
o Architect 0 Tenant 0 Agent ❑ Other -Q
PROJECT � PRIMARY PHONE �} � E-MAIL ADDRESS
CONTACT •�Y '1,_ \A) (3.1 [�J�ze
LENDER NAME Per RCW 19,27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
DETAILED BUILDING INFORMATION <
1
EXISTING USE myt-y /Y e',I PROPOSED USE R4 t 4, I -
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 4'04'
SPRINKLERED BUILDING? 0 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINEIII
0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER o LAKEHAVEN 0 HIGHLINE ❑PRIVATE(SEPTIC)
'�:7 f i I t • '•:,.;.'.,•..- • .
"' ... a ....:..'.,... uv ......msn.•M+.+mxv .... �. .. .,..uu....-.. ,... osnsi .. ...,e,mnim,w ,,,. msn ..,ie��.e�..tnanmrenv/n.... .
AREA DESCRIIN EXISTING PROPOSED TOTAL
1 SQ.FT. SQ. FT. SQ. FT.
BASEMENT
FIRSTf t( 36-1 gat: 'a
SECOND
THIRD •
ADDITIONAL FLOORS(DESCRIBE)
DECK(0 COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0 . •
EXISTING PROPOSED TOTAL TOTAL EXISTING ST TOTAL PROPOSED ST TOTAL.r
NUMBER OF FLOORS !
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
.a FIXTURES. `.,
. Indicate number of each type of fixture to be installed or relocated aspart of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPYO :ID OR ESTIMATE MUST BE INCLUD:JD WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE •OLERS GA* - 'E OUTLETS WOODSTOVES , 4
BBQS FANS . AS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS)Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS)or Tub/Shower Combo) LAVS :aurroomSinks) UR • •MISC(Descrioe;
li! DISHWASHERS
DRINKING FOUNTAINS
WATER SYST VACUU :BEAKERS
SHOWERS WATER CLOSETS,(Tose)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES. is
HOSE BIBBS SUMPS
SIGNATURE
I certify under.penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim), which may be made by any person,including the undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
. 7 r
NAME/TITLE ,.. l--' . -1.--- -� •DATE �7
(Signature) (Title) ' ii
,�w
RELATIONSHIP TO PROJECT o Owner 0 Agent 0 Contractor 0 Architect Other ii> .'z"f /'6n~
o NEW o ADDITION a ALTERATION To REPAIR a TENANT IMPROVEMENT. '
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES ❑NO
ZONING DESIGNATION CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? o YES o NO . UP/SEPA/SU? . o YES a NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
III
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Bulletin ly)O( —January ',:200- Pag..o c' I.\i-ianaouts\Permit Application